<div id="printBody" class="printBody">
    <div class="main" style="text-align: center;">
        <h1>急诊入院护理评估单</h1>
    </div>
    <div class="container">
        <div  style="page-break-after:always;">
            <table width="100%">
                <tr>
                    <td colspan="10">
                        <span class="jcxx_ty">姓名:<span id="name"></span></span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                        <span class="jcxx_ty">性别:<span id="sex"></span></span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                        <span class="jcxx_ty">年龄:<span id="age"></span></span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                        <span class="jcxx_ty">病床:<span id="bednum2"></span></span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                        <spam class="jcxx_blh">病案号:<span id="innum"></span></spam>
                    </td>
                </tr>
                <tr>
                    <td colspan="10">
                <span>单位/地址:&nbsp;<input type="text" maxlength="50" name="dwdz" id="dwdz" class="qt_input"
                                         style="width: 70%"
                                         placeholder="输入文字在50字以内"/></span>
                    </td>
                    <!--            <td colspan="9"></td>-->
                </tr>
                <tr>
                    <td colspan="3">
                        <span>就诊时间:&nbsp;&nbsp;</span>
                        <input type="text" class="qt_input" id="jzsj" name="date">
                    </td>
                    <td colspan="6">
                        <span>首诊科室:</span>
                        <input type="text" class="qt_input" id="szks" name="szks"/>
                        &nbsp;
                        <span>首诊医生:</span>
                        <input type="text" class="qt_input" id="szys" name="szys"/>
                    </td>
                </tr>
                <tr>
                    <td colspan="4">
                        <span>入抢方式:</span>
                        <div style="display: inline">
                            <input type="radio" id="walk" name="rqfs" value="0" checked><label for="walk">步行</label>
                        </div>
                        <div style="display: inline;padding-left: 30px">
                            <input type="radio" id="wheelchair" name="rqfs" value="1"><label
                                for="wheelchair">轮椅</label>
                        </div>
                        <div style="display: inline;padding-left: 30px">
                            <input type="radio" id="flatCar" name="rqfs" value="2"><label for="flatCar">平车</label>
                        </div>
                    </td>
                    <td colspan="1"></td>
                    <td colspan="5">
                        <span>入抢诊断:</span>
                        <input type="text" id="rqzd" name="rqzd" class="qt_input" style="width: 60%;"/>
                    </td>
                </tr>
                <tr>
                    <td colspan="5">
                        <span>既往病史:</span>
                        <div style="display: inline">
                            <input type="radio" id="jwbswu" name="jwbs" value="jwbswu" checked><label for="jwbswu">无</label>
                        </div>
                        &nbsp;&nbsp;&nbsp;&nbsp;
                        <div style="display: inline">
                            <input type="radio" id="jwbsyou" name="jwbs" value="jwbsyou"><label for="jwbsyou">有</label>
                            <input type="text" id="jwbsynr" class="qt_input" name="jwbsynr" style="width: 80px"/>
                        </div>
                    </td>
                    <td colspan="5">
                        <span>过敏史:</span>
                        <div style="display: inline">
                            <input type="radio" id="gmswu" name="gms" value="gmswu" checked><label for="gmswu">无</label>
                        </div>
                        &nbsp;&nbsp;&nbsp;&nbsp;
                        <div style="display: inline">
                            <input type="radio" id="gmsyou" name="gms" value="gmsyou"><label for="gmsyou">有</label>
                            <input type="text" id="gmsynr" class="qt_input" name="gmsynr" style="width: 80px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td colspan="4">
                        <span>入抢前用药情况:</span>
                        <div style="display: inline">
                            <input type="radio" id="rqqyyqkwu" name="rqqyyqk" checked value="rqqyyqkwu"><label
                                for="rqqyyqkwu">无</label>
                        </div>
                        &nbsp;&nbsp;&nbsp;&nbsp;
                        <div style="display: inline">
                            <input type="radio" id="rqqyyqkyou" name="rqqyyqk" value="rqqyyqkyou"><label
                                for="rqqyyqkyou">有</label>
                            <input type="text" id="ryqyyqkynr" class="qt_input" name="ryqyyqkynr" style="width: 80px"/>
                        </div>
                    </td>
                    <td colspan="6">
                        <span>紧急联系人:</span>
                        <input type="text" class="qt_input" id="jjlxr" name="jjlxr"/>
                        &nbsp;
                        <span>电话:</span>
                        <input type="text" class="qt_input" id="dh" name="dh"/>
                    </td>
                </tr>
                <tr>
                    <td colspan="10">
                        <hr>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div style="display: inline-block;width: 69px">
                            <b>生命体征</b>
                        </div>
                    </td>
                    <td colspan="9">
                    <span class="smtz_span">T<input type="text" class="qt_input" id="smtzT" name="smtzT"
                                                    style="width: 30px"/>°C&nbsp;</span>
                        <span class="smtz_span">P<input type="text" class="qt_input" id="smtzP" name="smtzP"
                                                        style="width: 30px"/>次/分&nbsp;</span>
                        <span class="smtz_span">R<input type="text" class="qt_input" id="smtzR" name="smtzR"
                                                        style="width: 30px"/>次/分&nbsp;</span>
                        <span class="smtz_span">BP<input type="text" class="qt_input" id="smtzBP" name="smtzBP"
                                                         style="width: 30px"/>mmHg&nbsp;</span>
                        <span class="smtz_span">SPO<sub>2</sub><input type="text" class="qt_input" id="smtzspo2"
                                                                      name="smtzspo2" style="width: 30px"/>%&nbsp;</span>
                        <span class="smtz_span">BS<input type="text" class="qt_input" id="smtzBS" name="smtzBS"
                                                         style="width: 30px"/>mmol/l</span>
                    </td>
                </tr>
                <td colspan="10">
                    <hr>
                </td>
                <tr>
                    <td><b>专项评估</b></td>
                    <td colspan="9">
                        <span class="zxpg_div scorePain">
                            疼痛
                            <input class="qt_input" style="width: 30px" type="text" name="painBP-text" id="painBP" data-score="pain" tabindex="37" data-name="基本资料>疼痛>疼痛评分" data-oldvalue="" aria-invalid="false">分
                            <input type="hidden" name="painScoreId-text" id="painScoreId" value="">
                        </span>
                        <!--                        <span class="zxpg_div">-->
                        <!--                        跌倒<input type="text" class="qt_input" id="zxpgdd" name="zxpgdd" style="width: 30px"/>分-->
                        <!--                    </span>-->
                        <span class="zxpg_div scoreFall">
                        跌倒<input style="width: 30px;" type="text"  class="qt_input" data-score="humptyDumpty"
                                 name="fallscore-text" id="fallscore-text" data-oldvalue="" aria-invalid="false">分
                        </span>
                        <span class="zxpg_div">
                        压疮<input type="text" class="qt_input" id="zxpgyc" name="zxpgyc" style="width: 30px"/>分
                    </span>
                        <span class="zxpg_div">
                        GCS<input type="text" class="qt_input" id="zxpgGCS" name="zxpgGCS" style="width: 30px"/>分
                    </span>
                    </td>
                </tr>
                <td colspan="10">
                    <hr>
                </td>
                <tr>
                    <td colspan="1" rowspan="2" valign="top"><b>瞳孔评测</b></td>
                    <td colspan="9">左&nbsp;&nbsp;直径<input type="text" class="qt_input" id="zzj" name="zzj"
                                                          style="width: 30px;"/>mm&nbsp;&nbsp;对光反应(
                        <div style="display: inline">
                            <input type="radio" id="zdgfylm" name="zdgfy" checked value="zdgfylm"><label
                                for="zdgfylm">灵敏</label>
                            <input type="radio" id="zdgfycd" name="zdgfy" value="zdgfycd"><label for="zdgfycd">迟钝</label>
                            <input type="radio" id="zdgfygd" name="zdgfy" value="zdgfygd"><label for="zdgfygd">固定</label>)
                        </div>
                        &nbsp;&nbsp;&nbsp;
                        其他(
                        <div style="display: inline">
                            <input type="radio" id="zqtyj" name="zqt" checked value="zqt"><label for="zqtyj">眼疾</label>
                            <input type="radio" id="zqtyy" name="zqt" value="zqtyy"><label for="zqtyy">义眼</label>
                            <input type="radio" id="zqtqs" name="zqt" value="zqtqs"><label for="zqtqs">缺失</label>
                            <input type="radio" id="zqtzz" name="zqt" value="zqtzz"><label for="zqtzz">肿胀</label>
                            <input type="radio" id="zqtbz" name="zqt" value="zqtbz"><label for="zqtbz">包扎</label>)
                        </div>
                    </td>
                </tr>
                <tr>
                    <td colspan="9">右&nbsp;&nbsp;直径<input type="text" class="qt_input" id="yzj" name="yzj"
                                                          style="width: 30px"/>mm&nbsp;&nbsp;对光反应(
                        <div style="display: inline">
                            <input type="radio" id="ydgfylm" name="ydgfy" checked value="ydgfylm"><label
                                for="ydgfylm">灵敏</label>
                            <input type="radio" id="ydgfycd" name="ydgfy" value="ydgfycd"><label for="ydgfycd">迟钝</label>
                            <input type="radio" id="ydgfygd" name="ydgfy" value="ydgfygd"><label for="ydgfygd">固定</label>)
                        </div>
                        &nbsp;&nbsp;&nbsp;
                        其他(
                        <div style="display: inline">
                            <input type="radio" id="yqtyj" name="yqt" checked value="yqtyj"><label for="zqtyj">眼疾</label>
                            <input type="radio" id="yqtyy" name="yqt" value="yqtyy"><label for="yqtyy">义眼</label>
                            <input type="radio" id="yqtqs" name="yqt" value="yqtqs"><label for="yqtqs">缺失</label>
                            <input type="radio" id="yqtzz" name="yqt" value="yqtzz"><label for="yqtzz">肿胀</label>
                            <input type="radio" id="yqtbz" name="yqt" value="yqtbz"><label for="yqtbz">包扎</label>)
                        </div>
                    </td>
                </tr>
                <tr>
                    <td colspan="10"><b>非创伤性评估</b></td>
                </tr>
                <tr>
                    <td>
                        <div class="di_dyg">神志:</div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="szq" name="sz" checked value="szq"><label for="szq">清</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="szss" name="sz" value="szss"><label for="szss">嗜睡</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="szmh" name="sz" value="szmh"><label for="szmh">模糊</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="szhs" name="sz" value="szhs"><label for="szhs">昏睡</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="szqhm" name="sz" value="szqhm"><label for="szqhm">浅昏迷</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="szshm" name="sz" value="szshm"><label for="szqhm">深昏迷</label>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>面色:</td>
                    <td>
                        <div>
                            <input type="radio" id="mszc" name="ms" checked value="mszc"><label for="mszc">正常</label>
                        </div>

                    </td>
                    <td>
                        <div>
                            <input type="radio" id="mswh" name="ms" value="mswh"><label for="mswh">萎黄</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="msha" name="ms" value="msha"><label for="msha">晦暗</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="msch" name="ms" value="msch"><label for="msch">潮红</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="msyh" name="ms" value="msyh"><label for="msyh">黝黑</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="msqz" name="ms" value="msqz"><label for="msqz">青紫</label>
                        </div>
                    </td>
                    <td colspan="3">
                        <div>
                            <input type="radio" id="msqt" name="ms" value="msqt"><label for="msqt">其他</label>
                            <input type="text" class="qt_input" id="msqtnr" name="msqtnr" style="width: 60px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>声音:</td>
                    <td>
                        <div>
                            <input type="radio" id="syzc" name="sy" checked value="syzc"><label for="syzc">正常</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="sysy" name="sy" value="sysy"><label for="sysy">嘶哑</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="syss" name="sy" value="syss"><label for="syss">失声</label>
                        </div>
                    </td>
                    <td>
                        <div style="display: inline-block;width: 120px">
                            <input type="radio" id="syyydw" name="sy" value="syyydw"><label for="syyydw">语音低微</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="syshy" name="sy" value="syshy"><label for="syshy">呻吟</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="radio" id="syqt" name="sy" value="syqt"><label for="syqt">其他</label>
                            <input type="text" class="qt_input" id="syqtnr" name="syqtnr" style="width: 60px"/>
                        </div>
                    </td>
                    <td colspan="2"></td>
                </tr>
                <tr>
                    <td>形体:</td>
                    <td>
                        <div>
                            <input type="radio" id="xtzc" name="xt" checked value="xtzc"><label for="xtzc">正常</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="xtfp" name="xt" value="xtfp"><label for="xtfp">肥胖</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="xtxs" name="xt" value="xtxs"><label for="xtxs">消瘦</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="radio" id="xtqt" name="xt" value="xtqt"><label for="xtqt">其他</label>
                            <input type="text" class="qt_input" id="xtqtnr" name="xtqtnr" style="width: 60px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>气道:</td>
                    <td>
                        <div>
                            <input type="radio" id="qdtc" name="qd" checked value="qdtc"><label for="qdtc">通畅</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="qdzs" name="qd" value="qdzs"><label for="qdzs">阻塞</label>
                        </div>
                    </td>
                    <td>
                    <span style="width: 69px">
                        <input type="radio" id="qdbfzs" name="qd" value="qdbfzs"><label for="qdbfzs">部分阻塞</label>
                    </span>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="radio" id="qdqt" name="qd" value="qdqt"><label for="qdqt">其他</label>
                            <input type="text" class="qt_input" id="qdqtnr" name="qdqtnr" style="width: 60px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td rowspan="2" valign="top">呼吸:</td>
                    <td colspan="9">
                    <span class="in_block">
                        <input type="radio" id="hxzc" name="hx" checked value="hxzc"><label for="hxzc">正常</label>
                    </span>
                        <span class="in_block">
                        <input type="radio" id="hxjc" name="hx" value="hxjc"><label for="hxjc">急促</label>
                    </span>
                        <span class="in_block">
                        <input type="radio" id="hxbq" name="hx" value="hxbq"><label for="hxbq">表浅</label>
                    </span>
                        <span class="in_block">
                        <input type="radio" id="hxhshx" name="hx" value="hxhshx"><label for="hxhshx">鼾声呼吸</label>
                    </span>
                        <span class="in_block">
                        <input type="radio" id="hxdtyhx" name="hx" value="hxdtyhx"><label for="hxdtyhx">点头样呼吸</label>
                    </span>
                        <span class="in_block">
                        <input type="radio" id="hxcx" name="hx" value="hxcx"><label for="hxcx">喘息</label>
                    </span>
                        <span class="in_block">
                        <input type="radio" id="hxwhx" name="hx" value="hxwhx"><label for="hxwhx">无呼吸</label>
                    </span>
                        <span class="in_block">
                        <input type="radio" id="hxqt" name="hx" value="hxqt"><label for="hxqt">其他</label>
                        <input type="text" class="qt_input" id="hxqtnr" name="hxqtnr" style="width: 60px"/>
                    </span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>
                            <input type="radio" id="hxkn" name="hx" value="hxkn"><label for="hxkn">困难</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="hxfl" name="hx" value="hxfl"><label for="hxfl">费力</label>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>循环:</td>
                    <td>
                        <div style="display: inline-block;width: 80px">
                            颈动脉搏动
                        </div>
                    </td>
                    <td colspan="5">
                        <div id="xhdxcl">
                            <input type="checkbox" id="xhkcj" name="xh" value="xhkcj"><label for="xhkcj">可触及</label>
                            <div id="xhkcjdxcl" style="display: inline-block">
                                &nbsp;(<input type="checkbox" id="xhkcjsl" name="xh" value="xhkcjsl"><label
                                    for="xhkcjsl">湿冷</label>
                                <input type="checkbox" id="xhkcjcb" name="xh" value="xhkcjcb"><label
                                    for="xhkcjcb">苍白</label>
                                <input type="checkbox" id="xhkcjmxs" name="xh" value="xhkcjmxs"><label
                                    for="xhkcjmxs">脉细速</label>
                                <input type="checkbox" id="xhkcjqt" name="xh" value="xhkcjqt"><label
                                    for="xhkcjqt">其他</label>
                                <input type="text" class="qt_input" id="xhkcjqtnr" name="xhkcjqtnr" style="width: 60px"/>)
                            </div>

                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="checkbox" id="xhxs" name="xh" value="xhxs"><label for="xhxs">消失</label>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>出血:</td>
                    <td>
                        <div>
                            <input type="checkbox" id="cxw" name="cx"><label for="cxw">无</label>
                        </div>
                    </td>
                    <td colspan="8">
                        <div id="cxdxcl">
                            <input type="checkbox" id="cxy" name="cx" value="cxy"><label for="cxy">有</label>
                            <div id="cxydxcl" style="display: inline-block">
                                &nbsp;(<input type="checkbox" id="cxykx" name="cx" value="cxykx"><label
                                    for="cxykx">咯血</label>
                                <input type="checkbox" id="cxyox" name="cx" value="cxyox"><label for="cxyox">呕血</label>
                                <input type="checkbox" id="cxybx" name="cx" value="cxybx"><label for="cxybx">便血</label>
                                <input type="checkbox" id="cxynx" name="cx" value="cxynx"><label for="cxynx">尿血</label>
                                <input type="checkbox" id="cxyydcx" name="cx" value="cxyydcx"><label
                                    for="cxyydcx">阴道出血</label>
                                <input type="checkbox" id="cxylncx" name="cx" value="cxylncx"><label
                                    for="cxylncx">颅内出血</label>
                                <input type="checkbox" id="cxyqt" name="cx" value="cxyqt"><label for="cxyqt">其他</label>
                                <input class="qt_input" type="text" name="cxyqtnr" id="cxyqtnr" style="width: 60px"/>)
                            </div>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>颈部:</td>
                    <td>
                        <div>
                            <input type="checkbox" id="jbzc" name="jb" value="jbzc"><label for="jbzc">正常</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="checkbox" id="jbjjmnz" name="jb" value="jbjjmnz"><label for="jbjjmnz">颈静脉怒张</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            吞咽困难&nbsp;
                            (<input type="radio" id="jbtyknw" name="jb" value="jbtyknw"><label for="jbtyknw">无</label>
                            <input type="radio" id="jbtykny" name="jb" value="jbtykny"><label for="jbtykny">有</label>)
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="checkbox" id="jbqt" name="jb" value="jbqt"><label for="jbqt">其他</label>
                            <input type="text" class="qt_input" id="jbqtnr" name="jbqtnr" style="width: 60px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td rowspan="3" valign="top">胸部:</td>
                    <td colspan="9">
                    <span>
                        <input type="radio" id="xbwxws" name="xbwx" value="xbwxws" checked><label
                            for="xbwxws">外形无殊</label>
                    </span>
                        <span>
                        <input type="radio" id="xbtzx" name="xbwx" value="xbtzx"><label for="xbtzx">桶装胸</label>
                    </span>
                        <span>
                        <input type="radio" id="xbxkjx" name="xbwx" value="xbxkjx"><label for="xbxkjx">胸廓畸形</label>
                    </span>
                        <span>
                        <input type="radio" id="xbpxnfy" name="xbwx" value="xbpxnfy"><label for="xbpxnfy">皮下捻发音</label>
                    </span>
                        <span>
                        <input type="radio" id="xobqt" name="xbwx"><label for="xobqt">其他</label>
                        <input class="qt_input" type="text" id="xobqtnr" name="xobqtnr" style="width: 60px"/>
                    </span>
                    </td>
                </tr>
                <tr>
                    <td colspan="9">
                        <div style="display: inline-block">
                            <label>呼吸音&nbsp;&nbsp;左&nbsp;</label>
                            <input type="radio" id="xbhxyzzc" name="xbhxyz" checked value="xbhxyzzc"><label for="xbhxyzzc">正常</label>
                            <input type="radio" id="xbhxyzjr" name="xbhxyz" value="xbhxyzjr"><label
                                for="xbhxyzjr">减弱</label>
                            <input type="radio" id="xbhxyzxs" name="xbhxyz" value="xbhxyzxs"><label
                                for="xbhxyzxs">消失</label>
                            <input type="radio" id="xbhxyzqt" name="xbhxyz" value="xbhxyzqt"><label
                                for="xbhxyzqt">其他</label>
                            <input class="qt_input" style="width: 60px" type="text" id="xbhxyzqtnr" name="xbhxyzqtnr"/>
                        </div>
                        <div style="display: inline-block">
                            <label>&nbsp;&nbsp;&nbsp;&nbsp;右&nbsp;</label>
                            <input type="radio" id="xbhxyyzc" name="xbhxyy" value="xbhxyyzc" checked><label for="xbhxyyzc">正常</label>
                            <input type="radio" id="xbhxyyjr" name="xbhxyy" value="xbhxyyjr"><label
                                for="xbhxyyjr">减弱</label>
                            <input type="radio" id="xbhxyyxs" name="xbhxyy" value="xbhxyyxs"><label
                                for="xbhxyyxs">消失</label>
                            <input type="radio" id="xbhxyyqt" name="xbhxyy" value="xbhxyyqt"><label
                                for="xbhxyyqt">其他</label>
                            <input class="qt_input" style="width: 60px" type="text" id="xbhxyyqtnr" name="xbhxyyqtnr"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>
                            疼痛
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="xbttw" name="xbtt" value="xbttw" checked><label for="xbttw">无</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="radio" id="xbtty" name="xbtt" value="xbtty"><label for="xbtty">有&nbsp;(部位</label>

                            <input class="qt_input" type="text" id="xbttynr" name="xbttynr" style="width: 60px"/>&nbsp;)
                        </div>
                    </td>
                </tr>
                <tr>
                    <td rowspan="6" valign="top">腹部:</td>
                    <td>
                        <div>
                            外形
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbwxpt" name="fbwx" value="fbwxpt" checked><label
                                for="fbwxpt">平坦</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbwxpl" name="fbwx" value="fbwxpl"><label for="fbwxpl">膨隆</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbwxax" name="fbwx" value="fbwxax"><label for="fbwxax">凹陷</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="radio" id="fbwxqt" name="fbwx" value="fbwxqt"><label for="fbwxqt">其他</label>
                            <input type="text" id="fbwxqtnr" name="fbwxqtnr" style="width: 60px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td colspan="8">
                        <div>
                            肠鸣音<input type="text" id="cmy" name="cmy" style="width: 60px"/>次/分&nbsp;&nbsp;&nbsp;&nbsp;
                            (<input type="radio" id="fbcmyzc" name="fbcmy" value="fbcmyzc" checked><label
                                for="fbcmyzc">正常</label>
                            <input type="radio" id="fbcmykj" name="fbcmy" value="fbcmykj"><label for="fbcmykj">亢进</label>
                            <input type="radio" id="fbcmyjr" name="fbcmy" value="fbcmyjr"><label for="fbcmyjr">减弱</label>
                            <input type="radio" id="fbcmyxs" name="fbcmy" value="fbcmyxs"><label for="fbcmyxs">消失</label>)
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>
                            腹肌
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbfjrr" name="fbfj" value="fbfjrr" checked><label
                                for="fbfjrr">柔软</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbfjjjz" name="fbfj" value="fbfjjjz"><label for="fbfjjjz">肌紧张</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbfjbkf" name="fbfj" value="fbfjbkf"><label for="fbfjbkf">板块腹</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="radio" id="fbfjqt" name="fbfj" value="fbfjqt"><label for="fbfjqt">其他</label>
                            <input type="text" class="qt_input" id="fbfjqtnr" name="fbfjqtnr" style="width: 60px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>
                            疼痛
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="checkbox" id="fbttw" name="fbtt"><label for="fbttw">无</label>
                        </div>
                    </td>
                    <td colspan="5">
                        <div id="fbttdxcl">
                            <input type="checkbox" id="fbtty" name="fbtt" value="fbtty"><label for="fbtty">有</label>
                            <div style="display: inline-block" id="fbttydxcl">
                                (<input type="checkbox" id="fbttyyt" name="fbtt" value="fbttyyt"><label
                                    for="fbttyyt">压痛</label>&nbsp;&nbsp;&nbsp;
                                <input type="checkbox" id="fbttyftt" name="fbtt" value="fbttyftt"><label for="fbttyftt">反跳痛&nbsp;&nbsp;部位</label>
                                <input class="qt_input" type="text" id="fbttyfttbw" name="fbttyfttbw" style="width: 60px;"/>)
                            </div>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>恶心呕吐</div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbexotw" name="fbexot" value="fbexotw" checked><label
                                for="fbexotw">无</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbexotexwt" name="fbexot" value="fbexotexwt"><label for="fbexotexwt">恶心未吐</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbexoty" name="fbexot" value="fbexoty"><label for="fbexoty">有</label>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>膀胱</div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbpgcy" name="fbpg" value="fbpgcy" checked><label
                                for="fbpgcy">充盈</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="radio" id="fbpgkx" name="fbpg" value="fbpgkx"><label for="fbpgkx">空虚</label>
                        </div>
                    </td>
                </tr>
            </table>
        </div>
        <div style="page-break-after:always;">
            <table width="100%">
                <tr>
                    <td rowspan="2" valign="top">大便:</td>
                    <td colspan="9">
                    <span>
                        <input type="checkbox" id="dbzc" name="db" value="dbzc"><label for="dbzc">正常</label>
                    </span>
                        <span>
                        &nbsp;&nbsp;<input type="checkbox" id="dbgz" name="db" value="dbgz"><label for="dbgz">干燥</label>
                    </span>
                        <span>
                        &nbsp;&nbsp;<input type="checkbox" id="dbnxb" name="db" value="dbnxb"><label
                                for="dbnxb">浓血便</label>
                    </span>
                        <span>
                        &nbsp;&nbsp;<input type="checkbox" id="dbljhz" name="db" value="dbljhz"><label
                                for="dbljhz">里急后重</label>
                    </span>
                        <span>
                        &nbsp;&nbsp;<input type="checkbox" id="dbbzdx" name="db" value="dbbzdx"><label
                                for="dbbzdx">便中带血</label>
                    </span>
                        <span>
                        &nbsp;&nbsp;<input type="checkbox" id="dbdbsj" name="db" value="dbdbsj"><label
                                for="dbdbsj">大便失禁</label>
                    </span>
                        <span>
                        &nbsp;&nbsp;<input type="checkbox" id="dbbyyb" name="db" value="dbbyyb"><label
                                for="dbbyyb">柏油样便</label>
                    </span>
                    </td>
                </tr>
                <tr>
                    <td colspan="2">
                        <div>
                            <input type="checkbox" id="dbqt" name="db" value="dbqt"><label for="dbqt">其他</label>
                            <input type="text" class="qt_input" style="width: 60px" id="dbqtnr" name="dbqtnr"/>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            大便次数<input type="text" id="dbcs" name="dbcs" class="qt_input" style="width: 40px"/>次
                            <input type="text" id="dbcsr" name="dbcsr" class="qt_input" style="width: 40px"/>日
                        </div>
                    </td>
                </tr>
                <tr>
                    <td rowspan="2" valign="top">小便:</td>
                    <td colspan="9">
                    <span>
                        <input type="checkbox" id="xbzc" name="xb" value="xbzc"><label for="xbzc">正常</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbhz" name="xb" value="xbhz"><label for="xbhz">浑浊</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbnzdx" name="xb" value="xbnzdx"><label for="xbnzdx">尿中带血</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbllbj" name="xb" value="xbllbj"><label for="xbllbj">淋漓不尽</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbdn" name="xb" value="xbdn"><label for="xbdn">多尿</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbsn" name="xb" value="xbsn"><label for="xbsn">少尿</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbnj" name="xb" value="xbnj"><label for="xbnj">尿急</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbnp" name="xb" value="xbnp"><label for="xbnp">尿频</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbnt" name="xb" value="xbnt"><label for="xbnt">尿痛</label>
                    </span>
                    </td>
                </tr>
                <tr>
                    <td colspan="9">
                    <span>
                        <input type="checkbox" id="xbnsj" name="xb" value="xbnsj"><label for="xbnsj">尿失禁</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbnzl" name="xb" value="xbnzl"><label for="xbnzl">尿潴留</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbwn" name="xb" value="xbwn"><label for="xbwn">无尿</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xblzdn" name="xb" value="xblzdn"><label for="xblzdn">留置导尿</label>
                    </span>
                        <span>
                        <input type="checkbox" id="xbqt" name="xb" value="xbqt"><label for="xbqt">其他</label>
                        <input type="text" id="xbqtnr" name="xbqtnr" class="qt_input" style="width: 60px"/>
                    </span>
                    </td>
                </tr>
                <tr>
                    <td>月经</td>
                    <td>
                        <div>
                            <input type="checkbox" id="yjzc" name="yj" value="yjzc"><label for="yjzc">正常</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="checkbox" id="yjxl" name="yj" value="yjxl"><label for="yjxl">絮乱</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="checkbox" id="yjtoj" name="yj" value="yjtoj"><label for="yjtoj">痛经</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="checkbox" id="yjjj" name="yj" value="yjjj"><label for="yjjj">绝经</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="checkbox" id="yjtj" name="yj" value="yjtj"><label for="yjtj">停经</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="checkbox" id="yjqt" name="yj" value="yjqt"><label for="yjqt">其他</label>
                            <input type="text" style="width: 60px" class="qt_input" id="yjqtnr" name="yjqtnr"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td colspan="10">
                        <hr>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>
                            <b>肌力评估</b>
                        </div>
                    </td>
                    <td>
                        <div>
                            <b>V级</b>
                        </div>
                    </td>
                    <td>
                        <div>
                            <b>IV级</b>
                        </div>
                    </td>
                    <td>
                        <div>
                            <b>III级</b>
                        </div>
                    </td>
                    <td>
                        <div>
                            <b>II级</b>
                        </div>
                    </td>
                    <td>
                        <div>
                            <b>I级</b>
                        </div>
                    </td>
                    <td>
                        <div>
                            <b>0级</b>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>左上肢</td>
                    <td>
                        <input type="radio" name="jlpgzsz" value="5" checked/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzsz" value="4"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzsz" value="3"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzsz" value="2"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzsz" value="1"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzsz" value="0"/>
                    </td>
                </tr>
                <tr>
                    <td>右上肢</td>
                    <td>
                        <input type="radio" name="jlpgysz" value="5" checked/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgysz" value="4"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgysz" value="3"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgysz" value="2"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgysz" value="1"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgysz" value="0"/>
                    </td>
                </tr>
                <tr>
                    <td>左下肢</td>
                    <td>
                        <input type="radio" name="jlpgzxz" value="5" checked/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzxz" value="4"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzxz" value="3"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzxz" value="2"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzxz" value="1"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgzxz" value="0"/>
                    </td>
                </tr>
                <tr>
                    <td>右下肢</td>
                    <td>
                        <input type="radio" name="jlpgyxz" value="5" checked/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgyxz" value="4"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgyxz" value="3"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgyxz" value="2"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgyxz" value="1"/>
                    </td>
                    <td>
                        <input type="radio" name="jlpgyxz" value="0"/>
                    </td>
                </tr>
                <tr>
                    <td colspan="10">
                        <hr>
                    </td>
                </tr>
                <tr>
                    <td><b>皮肤评估</b></td>
                </tr>
                <tr>
                    <td rowspan="2" valign="top">色泽:</td>
                    <td colspan="9">
                    <span>
                        <input type="checkbox" id="pfszzc" name="pfsz" value="pfszzc"><label for="pfszzc">正常</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszhr" name="pfsz" value="pfszhr"><label for="pfszhr">红润</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszcb" name="pfsz" value="pfszcb"><label for="pfszcb">苍白</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszch" name="pfsz" value="pfszch"><label for="pfszch">潮红</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszgz" name="pfsz" value="pfszgz"><label for="pfszgz">干燥</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszzg" name="pfsz" value="pfszzg"><label for="pfszzg">紫绀</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszhra" name="pfsz" value="pfszhra"><label for="pfszhra">黄染</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszhb" name="pfsz" value="pfszhb"><label for="pfszhb">红斑</label>
                    </span>
                        <span>
                        <input type="checkbox" id="pfszpz" name="pfsz" value="pfszpz"><label for="pfszpz">皮疹</label>
                    </span>
                    </td>
                </tr>
                <tr>
                    <td>
                        <div>
                            <input type="checkbox" id="pfszcxd" name="pfsz" value="pfszcxd"><label
                                for="pfszcxd">出血点</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="checkbox" id="pfszps" name="pfsz" value="pfszps"><label for="pfszps">破损</label>
                        </div>
                    </td>
                    <td>
                        <div>
                            <input type="checkbox" id="pfszyj" name="pfsz" value="pfszyj"><label for="pfszyj">痈疖</label>
                        </div>
                    </td>
                    <td colspan="2">
                        <div>
                            <input type="checkbox" id="pfszqt" name="pfsz" value="pfszqt"><label for="pfszqt">其他</label>
                            <input type="text" class="qt_input" id="pfszqtnr" name="pfszqtnr" style="width: 60px"/>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>水肿:</td>
                    <td>
                        <div>
                            <input type="radio" id="pfszhw" name="pfszh" value="pfszhw" checked><label
                                for="pfszhw">无</label>
                        </div>
                    </td>
                    <td colspan="3">
                        <div>
                            <input type="radio" id="pfszhy" name="pfszh" value="pfszhy"><label for="pfszhy">有&nbsp;&nbsp;(&nbsp;部位</label>
                            <input type="text" class="qt_input" id="pfszhybw" name="pfszhybw" style="width: 60px;"/>&nbsp;&nbsp;程度
                            <input type="text" id="pfszhycd" name="pfszhycd" class="qt_input" style="width: 60px;"/>&nbsp;)
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>压力损伤:</td>
                    <td>
                        <div>
                            <input type="checkbox" id="pfylssw" name="pfylss" value="pfylssw"><label
                                for="pfylssw">无</label>
                        </div>
                    </td>
                    <td colspan="8">
                        <div id="pfylssdxcl">
                            <input type="checkbox" id="pfylssy" name="pfylss" value="pfylssy"><label
                                for="pfylssy">有</label>
                            <div id="pfylssydxcl" style="display: inline-block">
                                &nbsp;&nbsp;(<input type="checkbox" id="pfylssyq" name="pfylss" value="pfylssyq"><label
                                    for="pfylssyq">I期</label>
                                &nbsp;&nbsp;<input type="checkbox" id="pfylsseq" value="pfylsseq" name="pfylss"><label
                                    for="pfylsseq">II期</label>
                                &nbsp;&nbsp;<input type="checkbox" id="pfylsssq" name="pfylss" value="pfylsssq"><label
                                    for="pfylsssq">III期</label>
                                &nbsp;&nbsp;<input type="checkbox" id="pfylsssiq" name="pfylss"
                                                   value="pfylsssiq"><label for="pfylsssiq">IV期</label>
                                &nbsp;&nbsp;<input type="checkbox" id="pfylsswq" name="pfylss" value="pfylsswq"><label
                                    for="pfylsswq">V期</label>
                                &nbsp;&nbsp;<input type="checkbox" id="pfylssbkfq" name="pfylss"
                                                   value="pfylssbkfq"><label
                                    for="pfylssbkfq">不可分期</label>
                                &nbsp;&nbsp;部位及范围<input type="text" class="qt_input" id="pfylssbkfqnr"
                                                        name="pfylssbkfqnr" style="width: 80px;"/>)
                            </div>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td>创口:</td>
                    <td>
                        <div>
                            <input type="checkbox" id="pfckw" name="pfck" value="pfckw"><label for="pfckw">无</label>
                        </div>
                    </td>
                    <td colspan="8">
                        <div id="pfckdxcl">
                            <input type="checkbox" id="pfcky" name="pfck" value="pfcky"><label for="pfcky">有</label>
                            <div id="pfckydxcl" style="display: inline-block">
                                &nbsp;&nbsp;(<input type="checkbox" id="pfckh" name="pfck" value="pfckh"><label
                                    for="pfckh">红</label>
                                &nbsp;&nbsp;&nbsp;&nbsp;<input type="checkbox" id="pfckz" name="pfck"
                                                               value="pfckz"><label
                                    for="pfckz">肿</label>
                                &nbsp;&nbsp;&nbsp;&nbsp;<input type="checkbox" id="pfckqjgz" name="pfck"
                                                               value="pfckqjgz"><label
                                    for="pfckqjgz">清洁干燥</label>
                                &nbsp;&nbsp;&nbsp;&nbsp;<input type="checkbox" id="pfckgz" name="pfck"
                                                               value="pfckgz"><label
                                    for="pfckgz">干燥</label>
                                &nbsp;&nbsp;&nbsp;&nbsp;部位及范围<input type="text" class="qt_input" id="pfckbwfw"
                                                                    name="pfckbwfw" style="width: 80px;"/>&nbsp;)
                            </div>
                        </div>
                    </td>
                </tr>
                <tr>
                    <td colspan="10">
                        <hr>
                    </td>
                </tr>
                <tr>
                    <td><b>护理措施</b></td>
                </tr>
                <tr>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsbdgxy" name="hlcs" value="hlcsbdgxy"><label
                            for="hlcsbdgxy">鼻导管吸氧</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsmzxy" name="hlcs" value="hlcsmzxy"><label
                            for="hlcsmzxy">面罩吸氧</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsqqtgnxy" name="hlcs" value="hlcsqqtgnxy"><label
                            for="hlcsqqtgnxy">气切套管内吸氧</label>
                    </td>
                </tr>
                <tr>
                    <td colspan="2">
                        <input type="checkbox" id="hlcskytqg" name="hlcs" value="hlcskytqg"><label
                            for="hlcskytqg">口咽通气管</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcshxpnfzhx" name="hlcs" value="hlcshxpnfzhx"><label
                            for="hlcshxpnfzhx">呼吸皮囊辅助呼吸</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsqgcg" name="hlcs" value="hlcsqgcg"><label
                            for="hlcsqgcg">气管插管</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsqgqk" name="hlcs" value="hlcsqgqk"><label
                            for="hlcsqgqk">气管切开</label>
                    </td>
                </tr>
                <tr>
                    <td colspan="3">
                        <input type="checkbox" id="hlcsxd" name="hlcs" value="hlcsxd"><label
                            for="hlcsxd">心电+BP+SPO<sub>2</sub>监护</label>
                    </td>
                    <td colspan="3">
                        静脉输液PV<input type="text" class="qt_input" id="hlcsjmsrPV" name=hlcsjmsrPV"
                                     style="width: 30px;"/>
                        CV<input type="text" class="qt_input" id="hlcsjmsrCV" name="hlcsjmsrCV" style="width: 30px;"/>
                    </td>
                </tr>
                <tr>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsxffs" name="hlcs" value="hlcsxffs"><label
                            for="hlcsxffs">心肺复苏</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsdjcc" name="hlcs" value="hlcsdjcc"><label
                            for="hlcsdjcc">电击除颤</label>
                    </td>
                </tr>
                <tr>
                    <td colspan="2">
                        <input type="checkbox" id="hlcslzwg" name="hlcs" value="hlcslzwg"><label
                            for="hlcslzwg">留置胃管</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcscwjy" name="hlcs" value="hlcscwjy"><label
                            for="hlcscwjy">肠胃减压</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcslzdn" name="hlcs" value="hlcslzdn"><label
                            for="hlcslzdn">留置导尿</label>
                    </td>
                </tr>
                <tr>
                    <td colspan="2">
                        胸腔引流管
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsxqylgz" name="hlcs" value="hlcsxqylgz"><label
                            for="hlcsxqylgz">左</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsxqylgy" name="hlcs" value="hlcsxqylgy"><label
                            for="hlcsxqylgy">右</label>
                    </td>
                </tr>
                <tr>
                    <td colspan="2">
                        腹腔引流管
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsfqylgz" name="hlcs" value="hlcsfqylgz"><label
                            for="hlcsfqylgz">左</label>
                    </td>
                    <td colspan="2">
                        <input type="checkbox" id="hlcsfqylgy" name="hlcs" value="hlcsfqylgy"><label
                            for="hlcsfqylgy">右</label>
                    </td>
                </tr>
                <tr>
                    <td colspan="10">
                        <input type="checkbox" id="hlcsqt" name="hlcs" value="hlcsqt"><label for="hlcsqt">其他</label>
                        <input type="text" class="qt_input" id="hlcsqtnr" name="hlcsqtnr" style="width: 200px"/>
                    </td>
                </tr>
                <tr>
                    <td colspan="10">
                        <hr>
                    </td>
                </tr>
                <tr>
                    <td colspan="2"></td>
                    <td colspan="3">
                        评估人员签名<input type="text" class="qt_input" id="pgryqm" name="pgryqm" style="width: 80px;"/>
                    </td>
                    <td></td>
                    <td colspan="3"><input type="text" class="qt_input" id="qmsj" name="date" style="width: 150px"/>
                    </td>
                </tr>
                <tr>
                    <td colspan="8"></td>
                    <td>
                        <button class="btn-emr btn-emr-green"  id="save">保存</button>
                        <!--                    <button id="save">保存</button>-->
                    </td>
                    <td>
                        <button class="btn-emr btn-emr-green"  id="print">打印</button>
                        <!--                    <button id="print">打印</button>-->
                    </td>
                </tr>
            </table>
            <input type="text" style="display: none" id="recordId"/>
        </div>
    </div>
</div>